Exhibit XIX ADJC Census Report.doc
DOC document 105 KB Posted
- Attached to
- Master Agreement AZ|CTR071439
- Contract number
- CTR071439
- Issued by
- Arizona
About this file
The document is an Exhibit XIX ADJC (Arizona Department of Juvenile Corrections) Census Report form designed for out-of-home residential contractors. The report is specifically for tracking bed space availability in Arizona residential programs, to be submitted electronically to the Community Program Service Office (CPSO) via email on the 1st and 15th of each month by 10:00 AM.
The report requires contractors to provide detailed information including their contact details, level of care (such as BHIF, BHRF, Group Home, or Other), specialty, gender, age range, number of open beds, location by city, and indication of upcoming discharges. The form is intended to help the ADJC monitor and manage residential program capacity, with contact support available at 602-527-5267 for training or assistance in completing the census report.
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Text version
EXHIBIT XIX
ADJC Census Report
Out-of-Home residential Contractors, please provide your bed space availability for AZ residential programs. Email the completed report on 1st and 15th of the month by 10:00 AM to the ADJC Community Program Service Office (CPSO) at communityprogramservice@azdjc.gov For training or assistance regarding this report, please contact the CPSO at 602-527-5267.
| Contractor name: |
| Census for the week of |
Contact person phone and email:
Level of Care
(BHIF, BHRF, Group Home or Other)
| Specialty |
| Gender |
| Age |
Range # of open beds Location (City) Upcoming
Discharges
(Y or No)
REV 6/20/22
File details come from the government source that posted it. Updated .